Mario L Gospodinoff, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036040279 Issued in IL

Practice address

1301 Enterprise Way
Marion, IL 62959-4442

Phone

(618) 993-1122

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Harrisburg Counseling Center LLC

  • Psychiatry Physician
  • Harrisburg, IL
  • NPI 1336179951
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303257600000",
    "number": "1942285572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 ENTERPRISE WAY",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629594442",
            "telephone_number": "618-993-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 ENTERPRISE WAY",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629594442",
            "telephone_number": "618-993-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSPODINOFF",
        "first_name": "MARIO",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2011-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036040279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036040279",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370966854011",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariel J Gonzalez
• Kristi Gooch
• Stacie Marie Goodloe, CMP
• Angela M Goodwin, LCSW
• Marie Jane Gorski, MD
• James Michael Gott
• Graham Family Medicine Inc
• Eric Sean Graham, MD
• Grady Jack Graham
• Harlie Graham

• Psychiatry Physician in Marion, IL
• Providers in Marion, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.